There has been little research that has used objective measures to evaluate levels of inattention in psychiatric disorders other than ADHD. The aim of this study was to examine sustained attention impairments in young adults across a range of psychiatric disorders.
Young adults aged 18–29 years who reported gambling at least five times in the previous year* were recruited from the Minneapolis and Chicago metropolitan areas. Participants received a psychiatric evaluation which included the WHO adult ADHD Self-Report Scale (ASRS), the Mini-International Neuropsychiatric Interview (M.I.N.I), the Minnesota Impulsive Disorders Interview (MIDI) and the Structured Clinical Interview for Gambling Disorder (SCI-GD).
Impairments in sustained attention were measured using the Rapid Visual Information Processing (RVP) task. In this task, participants must detect patterns of number target sequences.† Two types of data were collected: 1) impairments in target sensitivity (participants’ ability to distinguish between targets and non-targets) and 2) impairments in target detection (proportion of targets detected successfully). The effect size of each psychiatric disorder on sustained attention was quantified using z-scores; and the authors classified 0.3 as small, 0.5 as medium and 0.8 as large effect sizes.
Of 576 participants with a mean age of 22.2 years, 65% were women and 74% were educated to college degree level or higher.
Compared with data from participants without psychiatric disorders, almost all psychiatric disorders were associated with impairments in target sensitivity.
- Large effect sizes: bulimia nervosa, intermittent explosive disorder, obsessive-compulsive disorder (OCD) and social phobia.
- Small or medium effect sizes: ADHD, agoraphobia, alcohol dependence or abuse, antisocial personality disorder, any M.I.N.I disorder, binge-eating disorder, compulsive buying disorder, generalised anxiety disorder, substance dependence or abuse, depression, panic disorder and pathological gambling.
Similarly, almost all psychiatric disorders were associated with impairments in target detection.
- Large effect sizes: binge-eating disorder and OCD.
- Small or medium effect sizes: ADHD, agoraphobia, alcohol dependence or abuse, any M.I.N.I disorder, antisocial personality disorder, bulimia nervosa, compulsive buying disorder, depression, generalised anxiety disorder, intermittent explosive disorder, panic disorder, pathological gambling, social phobia and substance dependence or abuse.
In contrast, compulsive sexual behaviour disorder and post-traumatic stress disorder were associated with improved target sensitivity and detection scores; therefore, sustained attention was normal or improved.
There were several limitations of the study, including the small numbers of participants with some psychiatric disorders (minimum of five participants required for inclusion of the disorder in the study), and the cross-sectional design, which did not allow exploration of any causal relationships between the psychiatric disorders and attention impairment. In addition, as participants were recruited from the general population, the results may not be valid for clinical populations that could have higher levels of attentional problems. Finally, the study was not designed to consider the potential impact of comorbidities or the use of psychoactive substances.
The authors concluded that impairment of sustained attention is common in multiple psychiatric disorders such as eating disorders, OCD and social phobia. In light of these findings, the authors suggest a thorough psychiatric evaluation of people with sustained attention impairments, rather than simply diagnosing them with ADHD.
*Participants in this study were part of a wider longitudinal study that was enriched for gambling
†Participants are required to detect patterns of number target sequences, for example, 2-4-6. Participants look at a screen that shows single digits from 2 to 9 in a random order, at a rate of 100 digits per minute. Once they see the target sequence, they must respond by using the press pad as quickly as possible. The target sequences occur at a rate of four every 30 seconds, and the computer calculates the number of presses to target within 1.5 seconds after presentation.
Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.
Grant JE, Chamberlain SR. Attentional problems occur across multiple psychiatric disorders and are not specific for ADHD. CNS Spectr 2022; 20:1-4.